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International Journal of Medical Science and Health Research
Vol. 5, No. 01; 2021
ISSN: 2581-3366
Iron Deficiency Anemia
1,2
Swapana John, 1Dr. Prakash Chand Sharma
Author's Affiliation:
1.
Department of Zoology, S.P.C Government College, Beawar Road, Ajmer
2.
Department of Zoology, Sophia Girls' College (Autonomous), Ajmer
*Corresponding Author
Swapana John, Research Scholar, S.P.C Government College, Beawar Road Ajmer
Assistant Professor, Department of Zoology Sophia Girls' College (Autonomous), Ajmer
335001. Rajasthan, India
doi: 10.51505/IJMSHR.2021.5107 URL: http://dx.doi.org/10.51505/IJMSHR.2021.5107
Abstract
Aim: Iron deficiency anemia is a global concern affecting the lives of men and women, young
and old even children and infants. Iron deficiency continues to be the top-ranking reason for the
advancement of anemia even now. (Camaschella C., 2015). Thereby significantly affecting
greater part of the population in nearly every country in the world. Iron plays a vital role and is
indispensable from the basic reactions of the cell. Among the varied causes for the development
of anemia both in developed and developing countries, nutrition remains the top most reason.
(Osungbade & Oladunjoye, 2012) With references to the advances in the study and research of
systemic iron homeostasis, this review article aims to re-evaluates iron deficiency and its anemia
in and explores the causes, path physiological features, and a variety of treatment alternatives.
Method: The methodology applied is a narrative based descriptive study on articles from
PubMed, Google Scholar, web of Science. Conclusion: Iron Deficiency anemia when
undertaken seriously and detected well in advance can be prevented nonetheless nutrition has a
great role to play. Result: This study recommends to expand the quality of health services by
putting into action more handwork and to evolve with advanced facilities, it also suggests to
increase public awareness about anemia.
Keywords: Iron, Iron deficiency anemia, Hepcidin, treatment.
I. Introduction:
Anemia is predominant and widespread in most parts of the world. Iron -deficiency anemia
(IDA) is one of the universal reasons of anemia. Insufficient iron intake, poor gastrointestinal
absorption, or occult blood loss normally results into Anemia. To differentiate iron deficiency
from other causes of anemia is decisive to commence the proper medication, as is to ascertain the
primary cause of iron deficiency. (Besarab & Hemmerich, 2018)
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Iron performs a vital role as an essential micronutrient in numerous reactions in the human body.
Iron is indispensable from the fundamental biochemical activities because of its extraordinary
property to readily exchange electrons, correlate with proteins and oxygen binding ability.
Certain important proteins such as hemoglobin, myoglobin, and cytochromes, iron- Sulphur
clusters such as respiratory complexes and other functional groups has iron integrated in them.
Moreover, some of the vital functions including oxygen transport, mitochondrial respiration,
nucleic acid replication and repair have these proteins which have iron bound to them as their
important constituent. Nonetheless various enzymes such as peroxidases, ribonucleotide
reductase and P450 class of detoxifying cytochromes also need iron that serves as an important
role in their functions. (Powers & Buchanan, 2014;28)
Young children and premenopausal women particularly those of low income or in developed
countries are the worst hit by the iron-deficiency anemia. (McLean, Cogswell, Egli, Wojdyla, &
de, 2009;12) Insufficient dietary intake and /or colonization of intestinal worm leading to blood
loss, or both in general results in iron deficiency and iron deficiency anemia in developing
countries. Whereas selected and specific eating habits in higher-income countries such as
vegetarian diet and chronic blood loss or malabsorption are the frequent causes. In elder citizens
Iron deficiency is especially high in developed countries. (Kassebaum, Jasrasaria, Naghavi, & al,
2014;123)
II. Anemia - Its prevalence in developing and developed countries
Reduction in the hemoglobin concentration of the peripheral blood below the normal range as
expected for age and sex of an individual is termed as Anemia. (Standard treatment guidelines
Nigeria, 2008) According to the definition by The World Health Organization (WHO) anemia
develops when hemoglobin concentration found less than12g/dl in non-pregnant women over 15
years of age and below 11g/dl in pregnant women and less than 13g/dl for men over 15 years of
age. (Wick, Pinggera, & Lehmann, 2000). There occurs a disparity between the physiological
needs and the number of blood cells which results in a state wherein the number of red blood cell
or the oxygen carrying capacity is incapable to meet the physiological needs and this differs for
age, sex, altitude and pregnancy status. (Nutritional anemia: report of a WHO Scientific Group,
1968) If this criterion is taken into consideration there will be 10-20 percent of women and 6-30
percent of men above the age of 65 who may be anemic. Anemia forms a public health problem
in developing countries. About 2 billion people likely to suffer from anemia worldwide and it is
stated to account for three quarters of 1 million deaths a year in Africa and south -East Asia.
(Zimmermann & Hurrell, 2007) There can be diverse underlying reasons of anemia and are
largely escapable; these involve nutritional deficiencies, infections and hemoglobin disorders.
Nevertheless, it is evident that the occurrence of anemia in developing countries overdeveloped
countries is approximately four times higher. (Allen & Gillespie, 2001).
Children and pregnant women are the most susceptible groups in the population, while next
affected are the non-pregnant women and the elderly. In the developed countries it is predicted
that 10-20% of the preschool age children whereas in developing countries 30-80% are anemic
by the age of 1. (World Health Organization, 2005). The World health Organization (WHO)
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projected that of all pregnant women56% in developing countries are anemic. In North America
and Europe, the occurrence of anemia in pregnancy is about 17% in comparison to southern Asia
which is about 75% which is a huge contrast. Furthermore, 5% of pregnant women experience
adverse from of anemia in the worst affected parts of the world. (World Health Organization,
1992). Tragically, about 20% of maternal deaths are due to anemia; in addition, anemia adds
partly to 50% of all maternal deaths. (Rae, Erin, & Leslie, 2002;55(4)) Almost a similar
condition is seen in sub-Saharan Africa allegedly where anemia accounts for about 20% of all
maternal deaths. Incidentally this is brought about through three main reasons. (Buseri, Uko,
Jeremiah, &Usanga, 2008; 2) Firstly, blood loss during or after childbirth resulting in anemia
which makes the women more liable to death by lowering their hematological reserves.
Secondly, lowered resistance to disease increases susceptibility to infection which is associated
with severe anemia; and thirdly, high risk of cardiac failure and death associated when
hemoglobin (Hb) level falls less than 4g/dl predominantly during delivery or soon after, if
immediate intermediation is not introduced. (Rose & Thomas, 1996).
A very important impact to analyze resulting due to IDA is its effect on the economy. Iron
deficiency anemia triggers 25million cases of Disability Adjusted Life Years (DALY's) if we
talk in terms of lost years of healthy life, this reports for 2.4% of the entire global DALY's.
(World Health Organisation, 2011) Up to 4.05%losses in gross domestic product per annum
costs the developing countries due to physical a cognitive loss because of iron deficiency
anemia;(Horton & Ross, 2003;28) thereby filibustering social and economic development. Iron
Deficiency anemia (IDA) is the third prominent basis of disability-adjusted life years lost for
females aged 15-44 years according to The World Health Organization (WHO)/ World Banking
Ratings. (Karine & Friedman, 2007(1))
Paradoxically, owing to the aging population it becomes challenging and difficult to decrease
iron-deficiency anemia in high-income countries where its prevalence is found to be more as
compared to the in low-income countries. Elevated level of iron deficiency in aging populations
grounds for this apparent paradox. (Kassebaum, Jasrasaria, & Naghavi, A systematic Analysis of
Global Anemia Burden from 1990 to 2010, 2014;123)
III. Modification of Iron homeostasis in Iron deficiency
The hepcidin centered homeostatic control mechanism tightly regulates the iron acquisition.
(Hentze, Muckenthaler, Galy, & Camaschella, 2010) Hepcidin hormone which operates as an
acute-phase reactant is produced primarily by the liver. Hepcidin unite to ferroportin which is
responsible to ship iron from the cell and stimulate its degradation, thereby controlling the
fluctuations in plasma iron level triggered by absorptive enterocytes and macrophages in the
spleen. (Nemeth, Tuttle, Powelson, Vaughn, Donovan, & Ward, 2004)
There is a considerable and significant surge in the expression of hepcidin due to high circulating
and tissue levels of iron and in people suffering with systemic inflammation or infection. The
expansion of erythropoiesis, iron deficiency and tissue hypoxia in reply to the signs and
symptoms starting in the bone marrow, (Hentze, Muckenthaler, Galy, & Camaschella, 2010) the
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Vol. 5, No. 01; 2021
ISSN: 2581-3366
liver and probably muscle tissue and adipocytes may result in the obstructing of the making of
hepcidin. (Camaschella C., 2013)Increased hepcidin levels, especially interleukin-6 induced due
to inflammatory cytokines, justify the act of iron confiscation and downgrade supply of
erythropoietic iron that occur during anemia of chronic disease. (Camaschella C., 2015) Usually
in a population, the level of hepcidin for girls and young women are at a low level while men-
and postmenopausal women have a higher-levels;(Targlia, Girelli, & Biino, 2011)serum levels of
ferritin have a strong explicit association with rise and fall of hepcidin levels. (Galesloot,
Vermeulen, & GeurtsMoespot, 2011)Moreover in iron deficiency, the transcription of hepcidin is
restrained. (Camaschella C., 2015)
IV. Common Causes:
Anemia seldom occurs on its own, it usually co-exists with an underlying disease. In developing
countries, anemia mainly occurs due to nutritional disorders and infections predominantly among
the most vulnerable groups that is the pregnant women and preschool age children.
Any age group can develop deficiency of iron in the body leading to anemia. In general, it is
believed that 50% of instances of anemia are due to iron deficiency, (Moyle, 2002) but this may
contrast within population groups or environment.
Low intake of iron, poor absorption of iron from diet rich in phylate or phenolic compounds, and
early period of life when iron requirements are expectedly high are the threat factors of IDA.
(Osungbade &Oladunjoye, 2012) Likewise, iron requirements for iron in pregnant women are
highest accounting to 1.9mg/1000kcal of dietary energy in the second trimester and
2.7mg/1000kcal in the third trimester. The (1.0 mg) for infants,(0.8 mg) for adolescent girls, (0.6
mg) for adolescent boys, (0.6 mg) for non-pregnant women, (0.4mg) for preschool and school
age children, and (0.3mg) for adult men follow after the pregnant women in order according to
their needs. (Osungbade & Oladunjoye, 2012)Deficiency of Vitamin A can lead to the
occurrence of anemia. (Sommer & West, 1996) Animal products are comparatively consumed
less in developing countries which again lead to riboflavin deficiency (Camaschella C., 2013)
which is an important constituent for the synthesis of red blood cells and may be linked with
megaloblastic anemia. (Tolentino & Friedman, An update on anemia in less developed countries,
2007) The formation and maturation of red blood cells and cell growth and repair again
essentially requires folic acid. Folate deficiency diminishes the rate of DNA synthesis with
subsequent impaired cell proliferation and intramedullary death of resulting abnormal cells; this
shortens the lifespan of circulating red blood cells and thereby resulting in anemia. (Tolentino &
Friedman, 2007)
In developing countries, in addition to low intake of iron, people also suffer with intestinal
infection with nematodes; as a consequence, severe anemia develops, especially in the young
children. The real-time polymerase-chain-reaction assays of fecal samples outcome shows that
the gravity of iron deficiency intensifies if infection is coupled with Ancylostoma duodenale
(hookworm) (Jonker, Calis, & Phiri, 2012) Patients with hypermenorrhea may also have
concomitant malabsorption of iron. (Hershko & Camaschella, 2014)
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V. Diagnostic Procedure
To ascertain iron status and iron deficiency and associated conditions the traditional laboratory
measures and results are used. The most subtle and explicit test used for the detection of iron
deficiency is the Serum ferretin level test (indicated by a level ofInternational Journal of Medical Science and Health Research
Vol. 5, No. 01; 2021
ISSN: 2581-3366
like nausea, vomiting, constipation and metallic taste, although these are not very grave side
effects but are worrisome for the patients. (Camaschella C., 2015)
Parenteral Iron Supplements
The intravenous dispensation of iron diminished traditionally because of the likelihood of
hypersensitivity reactions to high molecular weight iron. This clinical practice has been modified
by the newly approved, safer iron formulations. (Onken, Bregman, & Harrington,
2014)Intravenous iron administration is effective and increases hemoglobin level more quickly
than oral iron absorption as a result intravenous iron circumvents the problem of iron.
(Vadhanraj, Strauss, & Ford, 2014) Another benefit is that in some patients a single infusion can
provide the total dose of up to 1000 mg. (Camaschella C., 2015) The dose required by the
individual is calculated with the formula i.e. body weight in kilogram * 2.3 * hemoglobin
deficiency (hemoglobin level target at–hemoglobin level of the patient) + 500 to 1000mg iron for
the repletion of ion stores. The cost is comparatively more for such sort of medication. Anyway,
there is a significantly reduced number of hospital or clinic visits over the years. (Bager &
Dahlerup, 2010)
Iron deficiency anemia can be considerably prevented by food fortification and dietary
diversification with iron which are an important measure (World Health Organization, 2005) for
the vulnerable group such as pregnant women and children. Although a number of strategies are
used to deliver additional iron to humans, but food fortification has the utmost potential to
enhance the iron status of the enormous number of people. (World Health Organisation, 1992)
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